April /May 2002

Diabetes -The Medical Perspective

Most everyone knows that hypertension, or high blood pressure, can be dangerous to health, but what exactly is it? Your veins don’t burst with high blood pressure the way water pipes might under a lot of pressure.

What does happen is that the veins and arteries become less "stretchy," so that they are more stiff and less flexible when blood flows through. This causes the pressure in the veins and arteries to increase. If the pressure gets very high, some of the pressure will be relieved by "backing up" to the heart or kidneys. This causes damages to these organs, and then they don’t function well. Sometimes the damage is permanent, and sometimes it can be reversed. However, sometimes these organs–the heart and kidneys–quit working altogether.

Hypertension is sometimes called the "silent killer," because people can’t feel high blood pressure. Although there are some signs or symptoms of hypertension, they are non-specific and easily overlooked.

If you have diabetes you are at a higher risk for heart disease and stroke, and having uncontrolled hypertension will increase this risk. Have your blood pressure checked at every doctor’s visit. The target range for those who have diabetes is below 130/80. The top number, the 130, is the systolic blood pressure. Systolic blood pressure represents the pressure in the heart during contraction. Diastolic blood pressure, the bottom number - 80, represents the pressure in the heart while it is relaxed.

Remember that your blood pressure can vary from day to day, and even according to the time of day. Several blood pressure readings per year are recommended - more often if your blood pressure tends to be high, you have a couple of high readings, or you have recently begun treatment for hypertension.

Diabetes and Food

If you have high blood pressure, there are two nutrition-related goals you and your health care team may set: maintaining or achieving a desirable weight; and reducing the amount of sodium (salt) in your diet. However, a more comprehensive dietary plan is called DASH, which stands for Dietary Approaches to Stop Hypertension.

The DASH diet can be incorporated into any diet for those with diabetes. It emphasizes an eating plan that is low in saturated fat, cholesterol, and total fat and higher in fruits, vegetables, and low-fat dairy foods. It also is lower in sodium than many dietary patterns.

The DASH diet recommends no more than 2,400 mg of sodium each day. This is a big reduction in dietary sodium for most people. To eat a diet this low in sodium, you need to do more than just avoid adding salt to your food. Many high sodium foods need to be avoided or eaten infrequently.

Tips to lower the sodium in your diet include:

• Buying fresh, plain frozen, or canned vegetables without added salt;
• Choosing ready-to-eat cereals that are lower in sodium;
• Use fresh poultry, fish, and lean meat instead of smoked or processed, such as hot dogs, ham, sausage, or luncheon meats;
• Choose convenience foods that are lower in sodium;
• Avoid salty snack foods and crackers

Exercise as a Part of Living

Even low-to moderate intensity activity can help lower your risk of heart disease. The National Heart, Lung, and Blood Institute/American Heart Association has a sample walking program that starts gradually and builds to 40 minutes of walking, at least three days per week.

Their plan always starts with 5 minutes of walking normally and 5 minutes of walking normally for the "cool down" period. In the first week, these experts recommend walking briskly for 5 minutes in between the "warm up" and "cool down" periods. The brisk walking period is then increased by 2-3 minutes each week in their 12 week program. This way you go slowly, and build up gradually!

Remember to consult your doctor before you start or increase your physical activity if you:

• have heart trouble or have had a heart attack;
• are taking medicine for high blood pressure or a heart condition;
• are over 50 and not used to much activity;
• have a family history of heart disease.

Recipes to Try

Whitefish Florentine

(4 servings)

2 pkgs. (10 oz. each) frozen chopped spinach
1/2 teas. salt
1 lb. whitefish fillets, about 1/2 inch thick
1 c. roasted red bell peppers
4 teas. dried basil
2 tbls. skim milk

1. Thaw spinach. Squeeze to drain.
2. Spread spinach evenly in ungreased 11 x 7" pan.
3. Blend in blender or food processor red pepper, basil, and milk.
4. Spread 1/2 of pepper mixture over spinach.
5. Arrange fillets next in pan. Top with remaining pepper mixture.
6. Cover and bake at 400° for 25 to 30 minutes, until fish flakes easily with fork.

Per serving :

Fluffy Muffins

(12 muffins)

1 cup low-fat cottage cheese
1 tbsp. sugar
1 egg
1 tbsp. Splenda®
1/2 cup flour
2 teas. poppy seeds
1 teas. vanilla
c teas. cream of tartar
2 teas. lemon juice
2 egg whites
4 drops yellow food coloring
1 tbsp. aspartame
3 tbsp. boiling water

1. Blend cottage cheese until smooth in food processor or blender. Add egg, flour, vanilla, lemon juice, sugar, Spenda®, poppy seed, and food coloring. Process until well blended.
2. Beat egg whites with mixer until they hold peaks. Add cream of tartar and continue mixing until soft.
3. Fold egg whites into cheese mixture. Pour into muffin pan which has been sprayed with non-stick cooking spray.
4. Bake at 300° for 20 minutes.
5. Combine aspartame with boiling water. Drizzle over muffins immediately.

Per serving:

Medication Update

For those who are taking insulin as part of their therapy for diabetes, three important concepts are:

• onset,
• peak, and
• duration of action.

"Onset" refers to how long it takes before your insulin starts really working. It isn’t instantaneous. Rapid-onset insulin starts lowering blood glucose 5 minutes after it is injected. Regular or short-acting insulin starts working about 30 minutes after it is injected. Intermediate-acting insulin reaches the bloodstream and starts being effective in about 2-4 hours. Finally, long-acting insulin begins to be effective 6-10 hours after injection.

"Peak" refers to when the insulin has its maximum strength in lowering blood glucose. Generally, you want your insulin to "peak" about 15-30 minutes after a meal because that is when your blood glucose will be highest. Rapid-acting insulin peaks in about an hour, so people generally take it before a meal. Regular insulin peaks in about 2-3 hours, intermediate in about 4-12 hours, and long-acting provides nearly continuous coverage after it becomes effective.

"Duration of coverage" refers to how long the insulin will remain active, even after its peak effectiveness. Rapid-acting works for only 2-4 hours, regular for 3-6 hours, intermediate for 12-18 hours, and long-acting for 18-28 hours.

There are many different types of insulin, so your regular schedule can be accommodated. Talk to your health care team, know your types of insulin and how they work, and discuss any changes in your normal routine.

New Resources

Facts About the DASH Diet are available online at http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/index.htm or from
National Heart, Lung, and Blood Institute Health Information Center
P.O. Box 30105, Bethesda, MD 20824-0105. Single copies are free.

An organization called the Medicine Program offers help in finding and applying for free medicines supplied by pharmaceutical companies. To request assistance, obtain an application form, available on its website or through the mail, and list the medicines you need. Send the application back with a $5 processing fee for each medicine listed (e.g., $20 when requesting four medicines). If the Medicine Program fails to qualify you to receive the medicine, your processing fee will be returned.

The Medicine Program
P.O. Box 515
Doniphan, MO 63935-0515
Phone: (573) 996-7300
Internet: www.themedicineprogram.com